Nearly six in ten low-income Californians say they would be interested in switching health care providers if they had a choice, according to a new, independent survey of poor and near-poor state residents.

And if the federal health reform passed last year is implemented as planned, many of those Californians will get that choice.

That new freedom could reshape the health care landscape in ways large and small. One thing it would do is force community clinics and health centers to be more responsive to patient needs, since many of those patients would have the ability to go elsewhere with federal subsidies and a state health insurance exchange open for business.

The survey was sponsored by the Blue Shield of California Foundation, which has worked with clinics and health centers to improve their operations and their reputations. (The foundation is also a sponsor of this web site, www.healthycal.org).

“We have an enormous population of Californians who will have the ability to go shopping for health care for the first time in their lives,” said Gary Langer, whose firm directed the poll. “They will be able to reach out and make choices about where they go for care.

“That creates a whole new world of risk and opportunity for the organizations currently focused on providing care for these people. Much of that care has been focused on what the funders and the organizers think needs to be done, rather than on what the patients want to have done.”

The survey questioned 1,005 Californians aged 19 to 64 with incomes below 200 percent of the federal poverty level, or about $45,000 for a family of four.

Among the findings:

–About four in ten say they currently have no choice in where they go for health care. About 44 percent use a community clinic or health center, about 30 percent go to private doctors and 1 in 10 use the Kaiser health care system. One in ten also said they simply rely on emergency rooms for their care.

–Low-income Californians are less healthy than state residents in general. One in three say they are disabled or chronically ill, and just one-third say health is excellent or good. Yet this group is no more likely than other Californians to get medical care. This means many may do so once they are given greater access to care under the new federal law.

–58 percent said they would be interested in changing health facilities if given the chance. Among community clinic patients, this rises to 73 percent.

–The most powerful driver leading people to want to change is the lack of a personal doctor. Among those who don’t have their own physician, 86 percent say they would be interested in going elsewhere.

–Looked at another way, about one third say having their own doctor is the most important thing about their health care provider. About the same number mentioned cost as the number one driver that would influence their choice, if they had one.

–The five factors found to predict a patient’s satisfaction with their facility were the courteousness of staff, patient involvement in medical decisions, the cleanliness of the facility, the amount of time the doctors spend with the patient and having a highly regarded personal doctor.

Peter Long, president and CEO of the foundation, said the findings should be a wake-up call for California’s clinics, because while many clinic patients are satisfied with their care, a large number say they would go elsewhere if they could.

Long said clinics and health centers, to compete in the new world of health care, are going to have to be more responsive to their patients by providing a regular doctor, accepting appointments instead of only walk-ins, and having clean, well-run facilities.

The good news, Long said, is that the clinics have “plenty of time” to make those changes before the law takes effect in 2014.

“I think these findings will drive transformation as much as anything we’re doing,” Long said.

Carmela Castellano-Garcia, president and CEO of the California Primary Care Association, said most clinics and health centers are already making the kind of changes that the patients in this survey said they want. She noted that a large majority of the respondents said they found clinic care to “good,” “very good” or “excellent.”